Coding Genicular Nerve Blocks and Ablations

This edition of “Spotlight on CPT” presents information on the coding for genicular nerve block(s) and ablation(s).  First things, first.  What is the genicular nerve?  This term refers to several sensory nerves that innervate the knee.  These include the femoral, common femoral, saphenous, tibial, and obturator nerves.  Blocks and ablations can reach several of these nerves and attempt to provide relief to patients with chronic pain from osteoarthritis of the knee. 

Here are a few pictures of that area.

In 2020, the CPT code updates, changed the way that these procedures should be coded.  Let us explore those changes. 

Previously, if a coding professional was assigning a code for a genicular nerve block, that code would have been 64450 for Injection, anesthetic agent; other peripheral nerve or branch.  There was a November 2015 CPT Assistant that instructed coders to only assign the code once for genicular nerve blocks, even if more than one nerve was injected. 

With the 2020 CPT code update, there is a new code for this procedure, 64454. The code’s definition is:  Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed.  Notes that follow the code instruct that all three branches must be injected in order to assign this code.  If all three branches-superolateral, superomedial, and inferomedial are not injected, then the code must have modifier -52 assigned to indicate the reduced services. 

If we turn our attention to an ablation or destruction procedure of the genicular nerve, we previously would have assigned 64640 for Destruction by neurolytic agent; other peripheral nerve or branch when coding for the genicular ablation.  A January 2018 CPT Assistant alerted coding professionals to assign the code three times if all three branches were destroyed and place modifier -59 on the second and third code.

Again, with the 2020 CPT code updates, we find a change.  Now we should assign 64624 for Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed for the ablation/destruction of the genicular nerve(s).  The same note follows this code detailing that all three genicular nerves must be destroyed in order to assign this code, or modifier -52 will need to be appended in order to indicate the reduced service.  Therefore, the advice in the January 2018 CPT Assistant is no longer relevant.

Bear in mind that coding professionals should not be assigning both 64454 and 64624 for the same encounter. 

Now, light has been shed on coding for genicular nerve blocks/ablations.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Uncertain Times

Unprecedented.  Challenging.  Chaotic.  Crisis.  These are words that most certainly apply to the world in which we currently find ourselves.  As we try to figure out how to exist both personally and professionally during this pandemic, this installment of “In the kNOW” will focus on what we as coding professionals can be doing during this difficult time.

As coding professionals, we are finding ourselves in a variety of circumstances.  Some of us may still be working full-time, especially if we are inpatient coders.  Others of us may have been furloughed, laid-off, or even terminated due to the reduction of services at facilities where we are employed.  Each situation has unique needs during this period.

For those still working, it is vital to keep up-to-date with the guidance being provided for coding COVID-19.  The American Hospital Association’s (AHA) Central Office on ICD-10-CM/PCS and the American Health Information Management Association (AHIMA) collaborated on COVID-19 FAQs which have undergone several updates.  Truly, all coding professionals, whether currently employed or temporarily laid-off, should be monitoring these updates and keeping an eye out for any future revisions.  COVID-19 is going to continue to be an issue for the foreseeable future and coding professionals are the key to collecting data that will be used in research.  It is vital that accurate and consistent application of the coding guidance is applied.

AHIMA has a list of resources available on their website which include coding, release of information, and clinical documentation improvement (CDI).  COVID-19 query templates were developed and are available for download.  There is also information on telehealth and HIPPA enforcement relaxation during the pandemic. 

For those coding professionals that may have more time on their hands, it is a great time to sharpen existing skills or gain new ones.  This can be achieved by taking a course either through AHIMA or one of their component state associations (CSA).  Many CSAs have on-line courses for purchase at reasonable rates.  Of course, there are also webinars that can help us learn or deepen our understanding of coding topics-or any health information management topic to be honest.  Don’t forget AHIMA’s Coffee and Coding webinar series, which is free again this year.

This could also be the time to look at updating your resume.  Granted, the job market might be tough at this moment, but taking the time now to revise a resume will put you a step ahead once jobs open again.  AHIMA has career prep tools on the website which can help.  If you are considering a new job, take some time to practice your interview skills.  This can be a critical step in the employment process and practice can give the necessary confidence to present our best selves.

Let’s look at this situation through a different prism now and see what words we find to focus on:

Temporary. Opportunity.  Life-long learning.  Growth.

This current situation, while challenging, is temporary.  It presents an opportunity for all coding professionals to take advantage of educational offerings and pursue personal growth.  We will emerge stronger than ever on the other side of this pandemic.  

Now you are In the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

Grandparents’ Goofs

by Dianna Foley, RHIA, CHPS, CCS 


Test your ICD-10-CM coding skills with this Klutz family experience.

During the family’s COVID quarantine, Mr. And Mrs. Klutz kept the children and their grandparents in touch via Look-In.  This enabled Mr. and Mrs. Klutz to check in on their parents and provided an opportunity for all of them to catch up.  In recent visits with both sets of grandparents, the children asked each of them to tell a story about a time when they had an injury.  As it turns out, each grandparent had a story to relate.  Test your ICD-10-CM injury and external cause coding skills by assigning the appropriate codes for the initial injuries sustained and any applicable late effects. 

Grandpa Klutz told about the time he worked on the railroad at the steel mill and got his left foot run over by a train.  He had displaced, closed fractures of the first and second metatarsals.  They healed well, but as a result, he now has a contracture of the second toe which causes him pain.

Grandma Klutz related that she used to work as a waitress at a local restaurant.  One day, she was using the plastic wrap that came in an industrial size package, with a very sharp, serrated edge for cutting to cover a bowl of vegetables she had just cut in preparation for the dinner rush.  As she was pulling off a piece of plastic, her right hand slipped and she cut her palm on the sharp edge.  To this day, she has a keloid scar on the palm of her hand which she showed the children.    

Mrs. Klutz’s father, Mr. Clodhopper, told how as a child he had accidentally been bitten by a rattlesnake on his left thigh.  He was on a hike in the forest with his family and had gone down to a creek where he had not noticed the snake sunning itself on a rocky outcropping.  As he saw a fish and called out to his brother to come and see, he startled the snake, which bite him.  Because it took some time to get out of the woods and to a hospital, the venom caused numbness in his left leg.  Later, this became a lifelong problem, eventually resulting in a shortened left femur and leaving Granddad Clodhopper with a limp.     

Granny Clodhopper was just a toddler when she developed nursemaid’s elbow after her dad had been playing with her in the park, swinging her around by her left wrist.  On occasion, she will have recurrent dislocations of the left elbow as a result of that injury.  

All were glad that the initial injuries weren’t any worse and that the grandparents, although perhaps still with some long-term effects of the injuries, were in all other respects well.  Choruses of “I love you” were exchanged all around with promises to visit again next week for more stories.
  

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